Nine year follow-up study of morbidity and mortality in retinal vein occlusion

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Abstract
Purpose The aim of this study was to conduct a detailed retrospective follow-up of a large cohort of patients with retinal vein occlusion (RVO), examining morbidity and mortality, to investigate a possible relationship between RVO, large vessel disease and stroke, and to determine whether recurrence of RVO was influenced by treatment of associated medical conditions. Methods A follow-up study was undertaken in 1994 of all patients (n = 588) who presented to the medical ophthalmology clinics of the Birmingham and Midland Eye Hospital between 1982 and 1989 with a definitive diagnosis of RVO. Results Follow-up data were obtained on 549 patients (93%). Results showed that recurrence of RVO in the same or fellow eye was decreased by more than half in the follow-up group (3.3%) when compared with the known recurrence rate at initial presentation (8.8%). Comparison of the deceased with the survivors showed that the deceased patients were significantly older (mean age 70.2 vs 63.4 years). The prevalence of rubeosis iridis and smoking were statistically significantly increased when comparing the deceased with the survivors (p < 0.016 and p < 0.008 respectively). The deceased had a higher prevalence of diabetes (15.8% vs 10.1%), and there was a trend towards increased clinically evident macrovascular disease in those patients who had died (23.2% vs 19.5%). Neither hypertension nor hyperlipidaemia predicted death, as the prevalence rates of the two conditions were similar in survivors and those who had died (60.0% vs 60.6% and 48.4% vs 53.3%). The percentage of patients taking antiplatelet drug therapy was not different in the two groups (36.8% vs 38.3%). Analysis of the causes of death of the RVO population (n = 95) compared with the causes of death in the West Midlands population as a whole, showed that the percentage of deaths from myocardial infarction in the RVO population was significantly higher (23.1% vs 14.4%, p < 0.05). There was no statistical difference between the populations for ischaemic heart disease and stroke, although there was a trend for increased mortality from stroke (19% vs 13.5%). Conclusion These data suggest a relationship between RVO, mortality and increased cardiovascular risk factors (smoking, diabetes and macrovascular disease), and support the possibility of an association between RVO and stroke. They also support the potential value of medical treatment of underlying medical conditions in preventing recurrence of RVO.